Understanding Addison's Disease -- Diagnosis & Treatment

How Is Addison's Disease Diagnosed?

Addison’s disease results from bilateral destruction of the adrenal glands, which sit atop your kidneys. Your adrenal glands are stimulated by your brain to produce cortisol under stress. Addison’s disease can present as an acute illness or come on gradually. A rare complication of Addison’s disease is adrenal crisis, which presents as shock, or very low blood pressure.  The risk increases if you are have an infection or a major physical stress.

With chronic Addison’s, the symptoms are vague and non-specific, and Addison's disease can be difficult to diagnose. Often, it's first detected through routine blood tests in a hospital or doctor's office to check for sodium, potassium and white blood cell levels. The doctor will also check for hyperpigmentation, or darkening, of the skin or gums -- a sign of long-term Addison's.

Other signs may include weakness, fatigue, poor appetite, low blood pressure, weight loss, and gastrointestinal symptoms.   

The most definitive way to diagnose the condition is to measure hormone levels in the blood before and after giving ACTH. ACTH is a hormone in the brain that, when activated, normally increases the amount of cortisol being produced by the adrenal glands. Measuring ACTH levels can help distinguish whether Addison's disease is a caused by a problem in the adrenal gland or the brain.

An evaluation of Addison’s disease can include a  CT scan of the adrenal glands to look for infection, cancer, or bleeding in the adrenal glands. A tuberculosis test may be done, as well, because up to 20% of cases are caused by tuberculosis. The majority, however, are immunological. 

What Are the Treatments for Addison's Disease?

Because Addison's disease is caused by a lack of normal hormones produced by the adrenal glands, it can be treated by replacing those hormones. This can be done with once- or twice-daily tablets of hydrocortisone, a steroid hormone. If needed, aldosterone can be replaced with a synthetic steroid, fludrocortisone acetate (brand name Florinef), which is taken orally once a day. These medications need to be increased during times of stress, infection, surgery, or injury.

Treatment is almost always completely successful. When treated, people with Addison's disease can lead a full and normal life. It is, however, important to carry a medic alert bracelet and emergency ID card at all times and to keep a small supply of medications at work or school. Even missing one dose can be dangerous.

In patients suspected of having an Addisonian crisis, doctor-prescribed injections of salt, fluids, and glucocorticoid hormones may be given immediately -- even before a diagnosis of Addison's disease is confirmed.

WebMD Medical Reference Reviewed by Sabrina Felson, MD on March 14, 2017

Sources

SOURCES: 

The Mayo Clinic. 

National Institute of Diabetes & Digestive & Kidney Diseases. 

National Adrenal Diseases Foundation. 

Jeremy Sussman, PhD, University of California Berkeley.

UpToDate.

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